JL Lycette is a novelist, award-winning essayist, rural physician, wife, and mother.
In “How to Solve a Medical Mystery” (Intima, Spring 2022), Dr. Brian Deady writes about the increasing reliance on computed tomography (CT) scans in the Emergency Room. He relates the story of diagnosing a patient in the E.R. with metastatic breast cancer by ordering a “fishing” CT scan in the evaluation of back pain. He reflects, “Now in hindsight, everything makes perfect sense. I had failed to uncover an important historical clue, which in turn caused me to skip what turned out to be a fundamental part of the physical assessment: the breast exam.”
After returning to the bedside to give the diagnosis to the patient and her husband, he continues with his shift. It is only later, “at the end of the shift, in the quiet of the physicians’ office,” that he reflects on how “it bothers me, perhaps more than it should, that I let a machine, a magical white doughnut of truth, make the diagnosis.”
He ponders, “In medicine, how do we ride the surging tide of technology without washing away the art?”
In my short story “No Human Bias Involved” (Intima, Fall 2022), I explore this conflict of humanity versus technology through the lens of fiction. Four decades in the future, an A.I. called “the Guardian” has saved our society from the ravages of multiple pandemics, and “healthcare stewards” now work for conglomerations with names like “Pfi-Mod-Nova” and “Wal-Glax-Zon.”
The main character, an older, former nurse named Julie, reflects on how “patients knew the Stewards had nothing to do with the decisions. It was all the Guardian’s objective algorithm.”
In a conversation with her supervisor, Julie asks, “Do you ever think about how the pandemic era only ended after people were willing to listen to something non-human?… how in the end, what we so painfully learned was, collectively, we all—as human beings—couldn’t be trusted to do the right thing for each other.”
Her supervisor counters, “I don’t think that was it at all. The A.I. was simply better at weighing the evidence, processing the data. It could identify the trends, and it ended all the speculation. Its objectivity reassured people.”
In Deady’s piece, he reflects on how the CT scan connected the patient’s intractable back pain with the lump in her breast, a connection the patient failed to make due to “a compartmentalized understanding of her own body.”
And while the CT scan made the connection easily, Deady cannot help but feel as if he should have done a more thorough exam from the get-go. To have made the diagnosis before the CT images revealed it.
In my fictional piece, Julie faces how she will cope with discovering that the technology is fallible.
In Deady’s piece, he ends by returning to the room and taking his patient’s hand.
I hope we will, as physicians and as humans, continue to do the right thing for our patients and each other, no matter how the technology advances.
JL Lycette is a novelist, award-winning essayist, rural physician, wife, and mother. Mid-career, she discovered narrative medicine on her path back from physician burnout and has been writing ever since. Her essays can be found in Intima, NEJM, JAMA, and other journals, and online at Doximity, KevinMD, and Medscape, where she is a regular contributor to Medscape Blogs. In fiction, she is an alumna of the 2019 Pitch Wars Mentoring program. Her speculative fiction is in the anthology And If That Mockingbird Don’t Sing: Parenting Stories Gone Speculative (Alternating Current Press). Her first novel, The Algorithm Will See You Now, a speculative medical thriller, is out March 2nd, 2023 (Black Rose Writing Press). Connect with her on Twitter @JL_Lycette or at jenniferlycette.com.